Provider Demographics
NPI:1376502500
Name:KHAN, MOHAMED F (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:F
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 SOUTHERN BLVD STE 3000
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1262
Mailing Address - Country:US
Mailing Address - Phone:937-531-0200
Mailing Address - Fax:937-531-0198
Practice Address - Street 1:1126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2687
Practice Address - Country:US
Practice Address - Phone:937-223-3053
Practice Address - Fax:937-853-0166
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.082601207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2431194Medicaid
OHP00058657OtherRAILROAD MEDICARE
OH4112824OtherMIDWEST U/S OHMEDI
OHP0007569OtherMIDWEST U/S RR MEDI
OHH459750Medicare PIN
OHP00058657OtherRAILROAD MEDICARE
OH4112823Medicare PIN